Mass. presses Morton Hospital to reconsider closing pediatric unit

Morton Hospital’s pediatric unit, slated to close next month, provides critical access to health care for children in the Taunton region, according to a strongly worded state finding that, though not binding, is meant to pressure the hospital to reconsider.

Steward Health Care, the for-profit hospital group that bought the troubled facility in 2011, has said it will close the 13-bed unit because it sees a low number of children and teens, with on average
fewer than one patient admission each day.

The company has struggled to find pediatricians to treat patients on the unit since a partnership with the Floating Hospital for Children at Tufts Medical Center ended recently, Steward spokesman Chris Murphy said.

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“We have no replacements,” he said.

Murphy said the unit admitted 284 patients in 2012 and saw 202 more for shorter observational periods. In a letter to the state, a leading pediatrician at Massachusetts General Hospital said an evaluation requested by Steward found that the level of admissions is not enough to provide safe and financially viable service. Caregivers who see more patients typically are seen as more practiced and proficient in their care.

But in a letter sent last week, Dr. Madeleine Biondolillo, director of the state Bureau of Health Care Safety and Quality, questioned the hospital’s figures, saying patient counts provided by hospital representatives have varied. She asked for clarification and a comprehensive analysis of the effects of the planned closing.

While the state can require Steward to evaluate the effects the proposal will have on patients, it cannot mandate that the unit stay open.

The review process has been used in previous cases to pressure hospital systems to consider community and state input.

Biondolillo cited concerns from people who testified at a May hearing that the hospital system had decided to close the unit without community input and that the change would require families to travel outside their community for acute care.

The pediatric services “are necessary for preserving access and health status in Morton Hospital’s service area,” the letter read.

Murphy said children who come to Morton’s emergency department are frequently transferred to Boston hospitals or to Hasbro Children’s Hospital in Providence for more advanced care.

The hospital plans to create a four-bed observation unit within the emergency department where children who need to be watched after an allergic reaction, an appendectomy, or for other conditions could be cared for in a locked room. That addition may need further state approvals.

But Biondolillo’s letter cited concerns that an emergency department, which may see people for trauma, psychiatric disorders, or substance abuse, is not the appropriate place for children to be cared for overnight.

That is a concern Dr. Eric Ruby, a longtime Taunton pediatrician, shares. “This is not how I would treat anybody in my family,” he said.

Strong pediatric care builds community support for a hospital, Ruby said. While the unit may not be a money-maker, it can build loyalty so that families will return to Morton for other kinds of care, he said.

Plus, he said, traveling to nearby big cities for care would be a financial burden for some low-income families.

Losing the unit would mean “every day there’s somebody who is going to be sent somewhere else,” he said. “Every day, there is going to be an ambulance ride.”

Dr. John O’Reilly, president of the state chapter of the American Academy of Pediatrics, submitted a letter to the state expressing concern about what he said is a pattern of pediatric unit closures at community hospitals.

“If this trajectory continues, timely access to pediatric care is in jeopardy,” he wrote.